Arregui-Gallego, BeatrizOrts-Cortes, Maria IsabelMoreno-Casbas, TeresaAbad-Corpa, EvaCamacho-Bejarano, RafaelaCidoncha-Moreno, Mª ÁngelesFeria-Raposo, IsabelIruzubieta-Barragán, JavierCarmona, MontserratCristóbal-Domínguez, EstíbalizBernués-Caudillo, LeticiaCasado-Ramirez, ElviraRecas-Martin, AldaSánchez-López, DoloresCompany-Sancho, M ConsueloRascón, Noelia LópezEsteban-Sepúlveda, SilviaVidal-Thomàs, María ClaraAlonso, IsabelMuñoz-Jiménez, DanielSegura-Heras, José VicenteMoncho, JoaquínRich-Ruiz, Manuel2025-12-122025-12-122025-06-16Arregui-Gallego B, Orts-Cortés MI, Moreno-Casbas MT, Abad-Corpa E, Camacho-Bejarano R, Cidoncha-Moreno MÁ, et al. (2025) Factors modulating the impact of the COVID-19 pandemic on posttraumatic stress symptomatology of the Spanish healthcare workers: A cohort study. PLoS One 20(6): e0323777. https://doi.org/10.1371/journal.pone.0323777https://hdl.handle.net/20.500.12105/27019Introduction: The COVID-19 pandemic generated a global health crisis that significantly impacted healthcare systems and professionals. Healthcare workers were exposed to high levels of psychological distress, including posttraumatic stress symptomatology (PTSS). Aim: Analyse the evolution of PTSS among Spanish healthcare workers during the COVID-19 pandemic, and to identify associated factors. Method: A multicenter prospective cohort study with a 12-month follow-up was conducted. PTSS was the primary outcome. Secondary variables included sociodemographic, occupational, psychological, and coping-related factors. Statistical analyses comprised bivariate comparisons and multivariate modelling, such as generalized linear models and linear mixed models. Results: Of the 428 participants, 180 completed the 12-month follow-up. At baseline, changes in work posts, negative family-work relations, avoidant coping, burnout symptoms, and emotional intelligence were associated with PTSS levels. Linear mixed models showed a significant decrease in PTSS over the 12-month period, regardless of gender, age, household type, occupational role, contract type, job title, level of care or type of service (p < 0.001). The generalised linear model explained 25.5% of the variance in PTSS levels at baseline, highlighting the role of psychological and coping factors over sociodemographic or occupational characteristics. Conclusions: This study highlights the need for early identification and intervention focused on psychological and coping mechanisms. Promoting emotional regulation, reducing burnout, and addressing maladaptive coping may help mitigate long-term psychological effects among healthcare workers during public health crises.engVoRhttp://creativecommons.org/licenses/by/4.0/Adaptation, PsychologicalAdultBurnout, ProfessionalCOVID-19FemaleHealth PersonnelHumansMaleMiddle AgedPandemicsProspective StudiesSARS-CoV-2SpainStress Disorders, Post-TraumaticAttribution 4.0 International40523034206e032377710.1371/journal.pone.032377710.1371/journal.pone.0323777.t00110.1371/journal.pone.0323777.t00210.1371/journal.pone.0323777.t00310.1371/journal.pone.0323777.t00410.1371/journal.pone.0323777.g00110.1371/journal.pone.0323777.t00510.1371/journal.pone.0323777.s001PLoS Oneopen access